PROLONGATION OF LOCAL ACTION OF COCAINE FOR SURGICAL PURPOSE.—By arresting the arterial and venous circu lation, Corning has demonstrated that when cocaine is injected into an ex tremity its action inay be prolonged for ninety minutes, if necessary. This arrest he accomplishes by the aid of appropriate ligature about the limb, or in the case of the breast or back by the application of rings, clamps, etc. He maps out the veins (to avoid puncture) by tying a piece of elastic webbing above the field of operation. As the veins become swelled he traces their course with a col ored pencil and then removes the web bing. Tbe limb is next exsanguinated with an ordinary Esmarch bandage car ried up to (but not beyond) the field of operation and maintained in place till the injections of the amnsthetic are com pleted. A strong fiat tourniquet is then applied about the limb above the field of operation and drawn tight enough to in terrupt the circulation in the vessels. The Esmarch bandage is then removed, and the field is ready for operation.
Case in which Est/larch's constrictor was applied immediately above the mai leoli; a solution of cocaine (1 per eent.) was then injected in the position of the different nerve-trunks, a number of dif ferent punctures being made with the needle. After an interval of three fourths of an hour, the operation took place; this consisted in the removal of the great toe, its metatarsal bone, and of the cuneiforms, in addition to scrap ing. with the sharp spoon and stitching of the skin. During the hour employed in these procedures, the patient was quite unaware of their progress. It is essential, in all cases in which it is de sired to completely arnesthetize the hand or foot, that the rubber tourniquet be very firmly applied, and that a sufficient interval (not less than twenty minutes) be allowed to clapge between the injec tion of the cocaine and the operation.
Otto Manz (Centralb. f. air., Feb. 19, '98).
Case in which an abdominal section was performed under cocaine anmsthesia for retroverted adherent uterus, owing to marked cardiac symptoms and goitre. Eight minims of 5-per-cent. solution of cocaine ha.ving been injected beneath the skin, an incision was made in the median line doWn to the muscle-sheath. Eight minims more were injected at different points along the median line into the muscular structures, and the incision was then carried into the peritoneal cavity. Tbe adhesions binding the uterus down to the rectum were then separated with out any- apparent discomfort to the pa tient. But even slight traction upon the ovaries seemed to produce considerable pain. The uterus was brought forward and stitched according to the ordinary suspension method. The peritoneum was closed by means of a continuous catgut suture. The patient made an uninter rupted convalescence. Hunter Robb (Cleveland Med. Gaz., Feb., '99).
Amputation under cocaine anmsthesia in a case of gangrene of the foot, the patient being too weak to take a general amosthetie. The limb was encircled with a broad elastic band, and two injections of cocaine solution made in the region of the main nerve-trunks. After waiting thirty minutes amputation at the knee was carried out almost painlessly. Berndt (Mtinchener med. Woch., July 4, '99).